GLOBAL PSYCHIATRY ARCHIVES

In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic. The Section on Suicidology and Suicide Prevention of the European Psychiatric Association (EPA) wants to raise awareness about the potential increase in mental health disorders and suicides as a result of the socio-economic impact of the COVID-19 pandemic, and of the necessary restrictive measures adopted worldwide to contain its spread. Even if fear, worries and symptoms of anxiety, depression and stress can be considered a natural response to this global crisis, some individuals are overexposed to its potential negative effects, such as healthcare workers, COVID-19 and psychiatric patients, prisoners, members of the LGBTQ+ community, migrants (including migrant workers), ethnic minorities and asylum seekers and internally displaced populations. Nevertheless, social support, resilience, a supportive work environment and other protective factors may buffer the impact of this crisis on mental health. These unprecedented times are calling for unprecedented efforts. Evidence-based and coordinated actions to prevent the risk of increased mental health disorders and suicide are needed. However, most of the data about COVID-19 impact on mental health comes from online surveys using non-probability and convenience sample in which females are often over-represented. For this reason the quality of future research should be also improved.

Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.
 
Methods
We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.
 
Results
404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.
 
Conclusions
Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.